IMPORTANCE: Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968. OBJECTIVE: To identify risk factors independently associated with poor outcomes in primary CSCC. DESIGN: A 10-year retrospective cohort study. SETTING: An academic hospital in Boston. PARTICIPANTS: Nine hundred eighty-five patients with 1832 tumors. MAIN OUTCOMES AND MEASURES: Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. RESULTS: The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6%) during the study period; 36 (3.7%) developed nodal metastases; and 21 (2.1%) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95% CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95% CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95% CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]). CONCLUSIONS AND RELEVANCE: Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7% risk of metastasis and 2.1% risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.
IMPORTANCE: Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968. OBJECTIVE: To identify risk factors independently associated with poor outcomes in primary CSCC. DESIGN: A 10-year retrospective cohort study. SETTING: An academic hospital in Boston. PARTICIPANTS: Nine hundred eighty-five patients with 1832 tumors. MAIN OUTCOMES AND MEASURES: Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. RESULTS: The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6%) during the study period; 36 (3.7%) developed nodal metastases; and 21 (2.1%) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95% CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95% CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95% CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]). CONCLUSIONS AND RELEVANCE: Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7% risk of metastasis and 2.1% risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.
Authors: Joana Lanz; Jan Nico Bouwes Bavinck; Marlies Westhuis; Koen D Quint; Catherine A Harwood; Shaaira Nasir; Vanessa Van-de-Velde; Charlotte M Proby; Carlos Ferrándiz; Roel E Genders; Véronique Del Marmol; Giulia Forchetti; Jürg Hafner; Domenic G Vital; Guenther F L Hofbauer Journal: JAMA Dermatol Date: 2019-01-01 Impact factor: 10.282
Authors: Ayse Selen Yilmaz; Hatice Gulcin Ozer; Jessica L Gillespie; Dawn C Allain; Madison N Bernhardt; Karina Colossi Furlan; Leticia T F Castro; Sara B Peters; Priyadharsini Nagarajan; Stephen Y Kang; O Hans Iwenofu; Thomas Olencki; Theodoros N Teknos; Amanda Ewart Toland Journal: Cancer Date: 2016-12-01 Impact factor: 6.860
Authors: Mackenzie R Wehner; Wilmarie Cidre Serrano; Adi Nosrati; Patrick Michael Schoen; Mary-Margaret Chren; John Boscardin; Eleni Linos Journal: J Am Acad Dermatol Date: 2017-11-13 Impact factor: 11.527
Authors: J Gillespie; L E Skeeles; D C Allain; M N Kent; S B Peters; P Nagarajan; L Yu; T N Teknos; T Olencki; A E Toland Journal: J Eur Acad Dermatol Venereol Date: 2015-03-12 Impact factor: 6.166
Authors: U Hillen; M Ulrich; M Alter; J C Becker; R Gutzmer; U Leiter; A Lonsdorf; A Messerschmidt; C Ulrich Journal: Hautarzt Date: 2014-07 Impact factor: 0.751